PROJECT SUMMARY Alcohol has been linked to morbidity and mortality resulting from intoxication, dependence and the biological consequences of alcohol use on organs and tissue. The relationship between alcohol and disease is especially concerning among those who exhibit heavy drinking episodes. The CDC estimates that 80,000 deaths are attributable to excessive alcohol use in the U.S. annually, making alcohol use the third-leading lifestyle-related cause of death. Alcohol use is particularly problematic among criminal justice populations as are alcohol-related adverse consequences such as mortality. While the issues have been well-documented, efforts thus far to identify strategies that effectively reduce alcohol-related harms have produced mixed results. The mixed results may be explained, in part, by the extent to which these interventions target those drinkers most likely to experience or impose harms and the extent to which the interventions successfully reduce drinking. The goal of this project is to determine whether North Dakota's 24/7 Sobriety Program for criminal justice offenders reduced morbidity and mortality in counties that implemented the program. North Dakota's 24/7 Sobriety Program (hereafter, ND 24/7) applies the concept of frequent alcohol testing in combination with swift, certain but modest sanctions for alcohol violations to offenders living in the community. Participants must submit to breathalyzer tests twice per day or wear continuous alcohol monitoring bracelets. Those testing positive or missing a test face an immediate, but brief, jail term. The program's primary goal is to reduce heavy drinking among this population and the criminal justice consequences of their alcohol use (e.g. repeat DUI). Although they have not yet been studied rigorously, the effects of the program are likely to extend to other alcohol-related outcomes ? with morbidity and mortality being among the most costly. Exploiting variation in the timing of the program's implementation across ND counties, we will employ quasi-experimental methods to determine whether the program influenced emergency room visits, hospital admissions and mortality. We will also assess whether implementation features (e.g. testing, exposure) influence outcomes. We will then use these findings to construct a measure of the program's benefits. The study's goal is to provide policymakers and other stakeholders with rigorous analyses of the program. The proposed study is innovative in its focus on the health- and mortality-related consequences of a targeted intervention to reduce the adverse consequences associated with alcohol use among those likely to impose the greatest costs on themselves and society. The proposed study team is uniquely qualified to conduct this study. They are currently evaluating ND 24/7's effects on DUI. And their NIAAA-funded evaluation of South Dakota's 24/7 Sobriety Project indicated that the South Dakota program reduced heavy drinking and, consequently, repeat drunk driving arrests, domestic violence arrests, and traffic crashes among young males.